Shatara Jackson, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Savannah, Georgia. Her current practice location is
5 Mall Anx, Savannah, Georgia. You can reach out to her office (for appointments etc.) via phone at
(912) 495-8887.
Shatara Jackson is licensed to practice in Georgia (license number CSW008276) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1033660949.
Healthcare Provider's Profile
| Full Name | Shatara Jackson |
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| Gender | Female |
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| Speciality | Social Worker - Clinical |
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| Location | 5 Mall Anx, Savannah, Georgia |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1033660949
- Provider Enumeration Date: 10/17/2016
- Last Update Date: 04/06/2023
Medicare PECOS Information:
- PECOS PAC ID: 9234508680
- Enrollment ID: I20221207002143
Medical Identifiers
Medical identifiers for Shatara Jackson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1033660949 | NPI | - | NPPES |
| 110026265E | Medicaid | MA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 15612 (South Carolina) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | CSW008276 (Georgia) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shatara Jackson allows following entities to bill medicare on her behalf.
| Entity Name | J.c. Lewis Primary Healthcare Center, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1922301472
PECOS PAC ID: 8426203225
Enrollment ID: O20130824000076 |
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| Entity Name | Nidesh Consulting Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1811607336
PECOS PAC ID: 7416326863
Enrollment ID: O20221207002024 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shatara Jackson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shatara Jackson, LCSW
50 S Parkwood Dr,
Savannah, GA 31404-5213
Ph: (912) 507-0326 | Shatara Jackson, LCSW
5 Mall Anx,
Savannah, GA 31406-4738
Ph: (912) 495-8887 |
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